1. Field of the Invention
The present invention relates to a treating apparatus and a treating device, which are used to coagulate or resect by heating living-body tissue.
2. Description of the Related Art
Conventionally, a medical treating apparatus is used to coagulate or resect by heating living-body tissue. For example, a coagulation treating device, a bipolar treating device, an ultrasound treating device and so on are known as treating devices used for the medical treating apparatus.
The coagulation treating device is used to coagulate or resect by heating living-body tissue, across which heaters as heat generating portions are provided at a distal end portion of a forceps. The bipolar treating device is used to coagulate living-body tissue by holding the living-body tissue between a pair of forceps and then flowing high frequency current therebetween. The ultrasound treating device is used to coagulate or resect by supplying ultrasound vibration to the distal end of the forceps to generate frictional heat within the held living-body tissue.
The coagulation treating device may be a thermal coagulation treating device having a heater as a heat generating portion at a resecting portion at the distal end of forceps, which is disclosed in the U.S. Pat. No. 5,792,137. Alternatively, the coagulation treating device may be a coagulation treating device, which is used to coagulate living-body tissue by using a heater provided as a heat generating portion at a distal end jaw part, which is disclosed in Japanese Unexamined Patent Application Publication No. 2001-190562.
In the coagulation treating device for coagulating living-body tissue by using a heater, it is easy to control a heating temperature on living-body tissue unlike the bipolar treating device. In addition, the coagulation treating device hardly sticks to living-body tissue because evaporation and cauterization of living-body tissue due to a rapid temperature change is not caused. Furthermore, the coagulation treating device has a feature that the thin and curved distal-end treating portion can be produced easily unlike the ultrasound treating device.
However, the conventional coagulation treating device generates thermal energy by a small heating member provided at the distal end portion of the forceps, which supplies heat to living-body tissue. Therefore, the conventional coagulation treating device can function satisfactorily with a thermal amount generated by the heating member if the living-body tissue to be coagulated is separated enough from the surrounding tissue or if the living-body tissue to be coagulated is dry in the progress of an operation. However, the living-body tissue cannot be coagulated efficiently because heat is diffused at the distal end of the forceps holding the living-body tissue if the living-body tissue to be coagulated cannot be separated from the surrounding tissue enough, or if the surrounding tissue is also needed to coagulate together, or if blood and/or body fluid stagnate around the living-body tissue to be coagulated. Thus, it takes time to complete the coagulation.
The ultrasound treating device has been proposed which is used to treat an affected part by touching the living-body tissue with the distal end treating portion, which gives ultrasound violation, as disclosed in the Japanese Unexamined Patent Application Publication No. Hei 4-212338 and Unexamined Patent Application Publication No. 2000-254136, for example.
The ultrasound treating device disclosed in the Japanese Unexamined Patent Application Publication No. Hei 4-212338 has a probe for transmitting ultrasound vibration, whose distal end portion is processed into a flat-plane form. In addition, a concave part (hook part) is formed therein. On the other hand, the ultrasound treating device disclosed in Japanese Unexamined Patent Application Publication No. 2000-254136 can be used not only for ultrasound treatment but also for treatment by high frequency current passage.
The ultrasound treating device disclosed in U.S. Pat. No. 5,013,312 has an ultrasound converter in the proximal end of a bipolar electrode. The bipolar electrode is vibrated with ultrasound such that living-body tissue can be resected. Upon the bipolar energization, the living-body tissue can be coagulated. The ultrasound treating device disclosed in U.S. Pat. No. 5,013,312 has an advantage that the ultrasound vibration can prevent living-body tissue from burning onto the bipolar electrode.
An ultrasound treating device disclosed in WO 99/65406 proposes a treating device whereby living-body tissue can be coagulated by using a heating unit (thick film heater pattern).
Furthermore, some ultrasound treating apparatus can perform treatment such as resection and coagulation of living-body tissue by using ultrasound energy. The ultrasound treating apparatus is proposed for treatment through ultrasound vibration by holding living-body tissue, as disclosed in Japanese Unexamined Patent Application Publication No. 2000-296135 and No. 2002-085420. The ultrasound treating apparatus disclosed in the Japanese Unexamined Patent Application Publication No. 2002-085420 is proposed as having a heat generating portion at the movable grasp portion.
On the other hand, a conventional surgical resector is proposed as resecting the meniscus and/or the cartilage by using a resecting blade, which rotates within an external tube for treatment on joint cavity as disclosed in the Japanese Unexamined Patent Application Publication No. Hei 5-220157 and No. Hei 6-311988.
However, each of the surgical resectors disclosed in the Japanese Unexamined Patent Application Publication No. Hei 5-220157 and No. Hei 6-311988 causes bleeding from capillary when living-body tissue is resected. Therefore, the surgical resector disclosed in the Japanese Unexamined Patent Application Publication No. Hei 6-311988 prevents it by applying high frequency current to the resecting blade.
A surgical resector having a heat generating portion at the distal end portion of a long and narrow inserting portion for the uses for allergy therapy is proposed as disclosed in the Japanese Patent Application No. 2001-48583, which is filed by the present applicant before.
However, each of the ultrasound treating devices disclosed in the Japanese Unexamined Patent Application Publication No. Hei 4-212338, No. 2000-254136 and U.S. Pat. No. 5,013,312 is used to treat living-body tissue and has a problem that homeostasis coagulation of living-body tissue takes time.
The ultrasound treating device disclosed in the WO 99/65406 performs fluropolymers coating in order to prevent living-body tissue from burning on due to the lack of ultrasound vibrator. Thus, the ultrasound treating device disclosed in the WO 99/65406 has a problem of low durability.
The ultrasound treating apparatus disclosed in the Japanese Unexamined Patent Application Publication No. 2000-296135 only can perform ultrasound treatment. Therefore, coagulation takes time or the operability is low when only coagulation is performed because the resection action also works together with the coagulation.
Thus, the ultrasound treating apparatus disclosed in the Japanese Unexamined Patent Publication No. 2000-296135 includes a heat generating portion at the removable grasp portion, which improves the coagulation power. However, the ultrasound treating apparatus disclosed in the Japanese Unexamined Patent Application Publication No. 2000-296135 requires another energizing unit for the heat generating portion at the removable grasp portion in addition to the energizing unit for the ultrasound vibrator, resulting in a more complicated structure.
In the surgical resector disclosed in the Japanese Unexamined Patent Application No. Hei 6-311988, noise is easy to mix into a motor drive circuit, for example, due to the energization of high frequency current. Therefore, the surgical resector disclosed in the Japanese Unexamined Patent Publication No. 6-311988 needs a measure against the noise, which causes the structure more complicated. Furthermore, the surgical resector disclosed in the Japanese. Unexamined Patent Application Publication No. 2001-48583 performs allergy treatment within a nose. Thus, living-body tissue such as cartilage cannot be resected.
In addition, a coagulation treating device, which can reset and staple (integration or joint) while stopping bleeding, is proposed, as disclosed in U.S. Pat. No. 5,624,452.
As disclosed in U.S. Pat. No. 5,611,798, a proposed coagulation treating device has a heat generating portion at the distal end and has 200° C./W or more of thermal resistance value at a part associating with living-body tissue and 100° C./W or less of thermal resistance value at a supporting portion of the engaged part. Thus, the heat influence when resecting living-body tissue can be reduced.
As disclosed in U.S. Pat. No. 4,074,719, for example, a proposed coagulation treating device has a control device for controlling a current supply unit, which is used to increase a temperature of a thermal element provided at the end with a predetermined temperature gradient until the temperature reaches to the temperature level which causes coagulation. After reaching to the temperature level, the temperature is maintained steadily. In addition, a freely audible instruction unit is provided thereto, which increases the strength of sound in accordance with the heat gradient until the temperature of the thermal element reaches to the temperature level. After the temperature of the thermal element reaches to the temperature level, a certain strength of sound is generated.
Furthermore, as disclosed in U.S. Pat. No. 6,228,080, for example, a proposed bipolar treating device applies an output again when the tissue impedance of living-body tissue does not indicate dry and adjusts the excess output in accordance with a degree of dryness of the living-body tissue.
As disclosed in U.S. Pat. No. 4,685,459, for example, a proposed bipolar treating device has a temperature sensor in the treating portion so as to display a temperature of a subject part and to control the temperature.
As disclosed in U.S. Pat. No. 5,707,369, for example, a proposed bipolar treating device has a temperature measuring unit and a comparing unit for comparing a changed amount in times and a threshold value so as to, for example, change an output control method for automatically stopping coagulation, for example.
As disclosed in U.S. Pat. No. 5,496,312, a proposed bipolar treating device has a detecting unit for detecting impedance or a temperature for every multiple active electrodes. Thus, the output control method can be changed so as to control in accordance with the detected value individually and independently.
As disclosed in U.S. Pat. No. 5,122,137, for example, a proposed bipolar treating device includes an RF conductor and an RF medical device, first and second pole connecting units, a temperature sensor and a control circuit. When RF output is not performed, a temperature is detected and the temperature in coagulation is controlled by controlling RF output.